gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Apolipoprotein A-IV and its relation to cardiovascular endpoints and all-cause mortality in patients on hemodialysis – the 4D Study

Meeting Abstract

  • Barbara Kollerits - Division für Genetische Epidemiologie, Medizinsche Universität Innsbruck, Innsbruck
  • Vera Krane - Nephrologische Abteilung, Universitätsklinikum Würzburg, Würzburg
  • Christiane Drechsler - Nephrologische Abteilung, Universitätsklinikum Würzburg, Würzburg
  • Claudia Lamina - Division für Genetische Epidemiologie, Medizinsche Universität Innsbruck, Innsbruck
  • Eberhard Ritz - Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg, Heidelberg
  • Christoph Wanner - Nephrologische Abteilung, Universitätsklinikum Würzburg, Würzburg
  • Florian Kronenberg - Division für Genetische Epidemiologie, Medizinsche Universität Innsbruck, Innsbruck

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds180

DOI: 10.3205/11gmds180, URN: urn:nbn:de:0183-11gmds1803

Published: September 20, 2011

© 2011 Kollerits et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: Apolipoprotein A-IV (apoA-IV) is a 46 kDa glycoprotein almost exclusively produced in intestinal enterocytes. In vitro studies suggest a role for apoA-IV in reverse cholesterol transport. ApoA-IV has been linked to hepatic lipid metabolism, physiological control of food intake, body weight and shows anti-atherogenic and anti-oxidative properties. It is an early marker of kidney impairment and is associated with progression of kidney disease. The aim of this study was to examine the association between apoA-IV, cardiovascular endpoints, all-cause mortality and parameters of protein-energy wasting and nutrition in patients on hemodialysis.

Methods: This post hoc analysis was performed in the 4D Study (German Diabetes Dialysis Study), which evaluates the efficacy and safety of atorvastatin in 1,255 patients with type 2 diabetes mellitus (T2DM) on maintenance hemodialysis treatment during 4 years of follow-up.

Results: Mean apoA-IV concentration at baseline was 49.8±14.2 mg/dL. A significant interaction between BMI, albumin and phosphate concentration and apoA-IV levels was detected. ApoA-IV was strongly associated with the presence of congestive heart failure at baseline (OR 0.78 (0.71-0.86) per 10 mg/dL increase, p=0.0000003). In the total group, patients with lower apoA-IV concentrations had a significantly higher risk for cerebrovascular events and a trend for higher risk for cardiac endpoints (death from cardiac causes and sudden cardiac death) observed during follow-up. The strongest association was found for all-cause mortality (HR 0.89 (0.84-0.95) p=0.0003), which was most pronounced in the BMI group >23 kg/m² (HR 0.87 (0.81-0.93), p=0.00005 (and the albumin group >3.8 g/dL) and remained significant after additionally adjusting for congestive heart failure. For the BMI group >23 kg/m² the same holds true for the cardiac and cerebrovascular events. Phosphate and apoA-IV levels interact in their effect on all cause mortality. For low phosphate levels (<2.4 mmol/L), decreasing apoA-IV levels have a significant impact on all-cause mortality. For high apoA-IV levels (>36.1 mg/dL), increasing phosphate levels have a significant impact on all-cause mortality.

Conclusion: Low apoA-IV levels seem to be a risk predictor for cardiac and cerebrovascular events as well as all-cause mortality in T2DM patients on hemodialysis that might be modified by wasting and nutrition.


References

1.
Wanner C, Krane V, März W, Olschewski M, Mann JFE, Ruf G, Ritz E, for the German Diabetes and Dialysis Study Investigators. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med. 2005;353:238-48.
2.
Tso P, Liu M. Apolipoprotein A-IV, food intake, and obesity. Physiol Behav. 2004;83:631-43.
3.
Kronenberg F, Stühlinger M, Trenkwalder E, et al. Low apolipoprotein A-IV plasma concentrations in men with coronary artery disease. J Am Coll Cardiol. 2000;36:751-7.
4.
Fouque D, Kalantar-Zadeh K, Kopple J et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73:391-8.